Surgical device

ABSTRACT

A surgical device includes a flexible inner tube having one end dipped in a liquid refrigerant, a flexible outer tube receiving the inner tube and having a freezing tip disposed at a distance from the other end of the inner tube to define a space therebetween, and a vacuum pump for evacuating the outer tube and space, so that the refrigerant is introduced into the space through the inner tube to be evaporated therein to cool the freezing tip.

[ 1 Jan. 14, 1975 United States Patent [1 1 Okada et al.

1.11111 1. 333.5%3 0000 0 3333003 ////2/ onoooooo oo 2222 2 llll lmmmfllum un t.an mflh m e mmSd a k. w mmac amoymm, hahe r CLTRYB 60000 2667777 999999 l l l l ll 9000223 J an ap Primary Examiner-Channing L.Pace [22] Filed: June 20, 1973 [21] Appl. No.: 371,935

ABSTRACT A surgical device includes a flexible inner tube having one enddipped in a liquid refrigerant, a flexible outer tube receiving theinner tube and having a freezing tip disposed at a distance from theother end of the inner %15 3 07 3 B1 0 8b B 21800 1 6%2 9 1 M J 0%0 O 8/1 y 6 Ibo .1 m6/ m mml m. h nnc a ""e "ms L C WM te I III- U'mF .llzl.218 555 [ll tube to define a space therebetween, and a vacuum pump forevacuating the outer tube and space, so that the refrigerant isintroduced into the space through References Cited UNITED STATES PATENTSthe inner tube to be evaporated therein to cool the freezing tip.

2,583,937 Fossati........ 128/303.l5 x 2,672,032 11 Claims, 4 DrawingFlgures 3/1954 Towse....................... 128/3031 UXFill/III!!!lvlvilillllllllith PATENTED JAN 1 41975 SHEEI 10F 3 FIG.

SURGICAL DEVICE BACKGROUND OF THE INVENTION This invention relates to asurgical device for freezing and treating the diseased portion of thecavity wall such as the inner wall of the stomach.

In surgical operations for cancer of the urinary bladder, hypertrophy ofthe prostatic gland and the like, there is commonly used a surgicaldevice for freezing the diseased portion to destroy the affectedcellular tissue. In the device, the diseased portion is frozen by afreezing metal tip which is cooled in contact with and by evaporation ofa liquid refrigerant such as liquid nitrogen. The liquid refrigerant issupplied from a refrigerant container through an innertube to beevaporated near the metal tip and then the evaporated refrigerant isdischarged through an outer tube.

In the conventional device, such a liquid refrigerant is supplied intothe first tube by means of pressuring the liquid in the container. Sucha means tends to give rise to a complicated construction anddifficulties in adjusting the temperature of the metal tip. Furtherother means to thermally insulate a liquid refrigerant flowing throughthe inner tube from the outside is unable to satisfy the followingrequirements. The means has been required to have an excellentinsulation and permit the outer tube to be of a small outer diameter.

SUMMARY OF THE INVENTION It is an object of this invention to provide asurgical device which is simple in construction andprovides sufficientlycontrollable low temperature for freezing the diseased portion.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a sectional view of asurgical device having a surgical instrument and a cystoscope; v

FIG. 2 is a side view .of a surgical device having the surgicalinstrument and another cystoscope;

FIG. 3 is a perspective view of an endoscope combined with the surgicalinstrument; and

FIG. 4 is an enlarged sectional view showing the part of the endoscopeillustrated in FIG. 3.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS FIG. 1 shows asurgical device having a surgical instrument l and a cystoscope 2 toperform an operation for cancer of the urinary bladder. The surgicalinstrument 1 includes an elongated flexible outer tube 3 formed of, forexample, polytetrafluoroethylene or synthetic resin and a flexible innertube 4 of a freezingresistant material e.g., fluorine resin which isinserted in the outer tube 3. The outer diameter of the inner tube 4 ismade slightly smaller than the inner diameter of the outer tube 3 so asto provide a cylindrical space between the tubes 3 and 4. The outertube, however, is movably disposed relative to the inner tube.Preferably, the outer tube 3 has a plurality of adiabatic ribs on itsinner surface which extend in the lengthwise direction and are equallyspaced apart from each other so that the inner tube 4 may be .coaxiallysupported by the outer tube 3. This insures that refrigerant flowingthrough the inner tube is thermally insulated from the outer tube 3.Alternatively, it is possible to form adiabatic ribs on'the outersurface of the inner tube 4.

A freezing metal tip 5 is sealingly mounted on one end of the outer tube3. A nozzle 6 is formed at one end of the inner tube 4 and slightlyspaced apart from the inner surface of the metal tip 5 to define a spacetherebetween.

A rigid inner sleeve 7 is tightly connected at one end to the other endof the outer tube 3. The inner sleeve 7 is slidably inserted in an outersleeve 8 which is closed at one end facing the other end of the innersleeve 7. An O-ring seal 9 is fitted on the outer wall of the innersleeve 7 so as to enable the inner sleeve 7 to slide through the outersleeve 8 in an air-tight manner. A threaded hole is formed in the sidewall of the outer sleeve 8, preferably near the open end of the outersleeve 8. A screw 10 is inserted in the threaded hole to fix the innersleeve 7 to the outer sleeve 8. Since the outer tube 3 is connected tothe inner sleeve 7 and the inner tube 4 is fixed to the outer sleeve 8,the distance between the nozzle 6 and the metal tip 5 is easily adjustedby sliding the inner sleeve 7 through the outer sleeve 8. The adjusteddistance may be maintained by tightening the screw 10 to fix the innersleeve 7 to the outer sleeve 8.

An exhaust pipe 11 is connected at one end to the outer sleeve .8 nearthe closed end and at the other end to a vacuum pump 12. The exhaustpipe 11 has a vacuum gauge 12a so as to measure vacuum pressure in theexhaust pipe 11, outer sleeve 8, inner sleeve 7, and the outer tube 3.

The inner tube 4 inserted in the outer tube 3 extends through sleeves 7and .8 into refrigerant such as a liquid nitrogenin a refrigerantcontainer 13. To the end of the inner tube 4 dipped in the refrigerantis attached a filter 14 which permits only the refrigerant to passthrough the inner tube 4. Part of the inner tube 4 extending from theclosed end of the outer sleeve 8 to the container 13 is covered with anadiabatic member 15 of, for example, polystyrene foam.

The surgical instrument 1 may be assembled with the cystoscope 2 whereinthe end portion of the outer tube 3 is inserted movably through thesheath 16 of the cystoscope. The freezing tip 5 is extended from one endof the sheath 16. A light guide 17 made of an optical fiber bundle isinserted into the sheath 16 to illuminate the area around the diseasedpart and freezing tip 5. The sheath 16 is provided with a water inlet 18and outlet 19 to pass the water through the sheath thereby melting theice formed on the periphery of the outer tube 3.

The operation of the surgical instrument 1 and cystoscope 2 to treatcancer of the urinary bladder is described below.

First, the diseased portion is located with-the naked eye through thesheath while illuminating the inner wall of the urinary bladder. Then,the freezing tip 5 is brought close to the diseased portion. In thiscondition, the outer sleeve 8 and outer tube 3 are evacuated byoperating the vacuum pump 12 so that the refrigerant in the container 13may be conducted through the inner tube 4 to the nozzle 6 and projectedfrom the nozzle 6 to the freezing tip 5. The refrigerant, when projectedfrom the nozzle 6, is evaporated and discharged through the outer tube3. The freezing tip 5 is cooled in contact with the refrigerant and alsoby evaporation of the refrigerant. While observing both the tip 5 andthe diseased portion through the cystoscope 2, the tip 5 which is cooledis brought into direct contact with exactly the diseased portion tofreeze the diseased portion and treat the cancer of the urinary bladder.

Another type of the cystoscope which may be assembled with the surgicalinstrument 1 will be illustrated with reference to FIG. 2.

The cystoscope 20 includes a sheath 21 with a closed top end, an opening22for the surgical instrument and window 23. A telescope 24 is slidablyinserted in the sheath through a guide formed in the sheath, which isprovided with an ocular 25 at one end and an observing window 26 at itsother end. An optical system constructed with lenses and a prism ismounted in the telescope 24 to optically connect the ocular 25 to theobserving window 26. The telescope 24 is further provided with a lightguide 27 made of a bundle of optical fibers, which guides a light from alight source (not shown) to the windows 23, 26.

The flexible outer tube 3 of the surgical instrument 1 is insertedthrough the sheath 21' at an opening formed on the base side thereof.The top portion of the outer tube 3 and metal tip 5 are extended fromthe opening 22 near the window 23. The extended portion of the outertube 3'may be controlled to vary its inclined angle to the longitudinalaxis of the telescope by operating an angle adjusting mechanism 28. Themechanism 28 may be designed to have the same construction as aconventional forceps raising mechanism of an endoscope. The mechanism 28includes a pivoted arm mounted in the sheath and a wire one end of whichis connected to the arm and the other end of which is connected to alever 29 mounted on the base of the sheath. The arm may be pivoted bythe operation of the lever 29 to change the inclined angle of the outertube 3.

The operation of the surgical device shown in FIG. 2 is substantiallysimilar to that of FIG. 1 and thus omitted in the description.

FIGS. 3 and 4 show a well known endoscope 30 combined with the surgicalinstrument 1 described above, which includes a control unit 31, aflexible tube 32 to be inserted into the body cavity and a distal end 33attached to the end of the flexible tube 32. The distal end 33 isprovided with a viewing window 34, an illuminating window 35 forilluminating the viewing field of the window 34 and a forceps opening36, which are formed on the front side of the distal end 33. The viewingwindow 34 is optically connected to an ocular 37 mounted on the controlunit 31 through a bundle of optical fibers arranged in the flexible tube32. The illuminating window 35 is optically connected to a light source(not shown) through a light guide disposed in the flexible tube 32 andcontrol unit 31. The control unit 31 also includesa forceps inletopening 39 through which a forceps (not shown) may be inserted into theforceps channel provided in the flexible tube 32 until the end of theforceps extends out through the forceps opening 36 of the distal end 33.In the distal end near the forceps opening 36 there is arranged aforceps raising mechanism 40 which is mechanically connected to thecontrol unit 31 through a wire, so that the raising mechanism 40 isoperated by the control unit 31 to change the inclined angle of theextended portion of the forceps. The endoscope 30 is further providedwith a bending mechanism (not shown) which is also operated by thecontrol unit to adjustably vary the bending angle of the portion of theflexible tube 32 near the distal end 33.

In operation, the surgical instrument 1 is combined with the endoscope30, as shown in FIG. 3. The outer tube 3 of the surgical instrument isinserted into the forceps inlet opening 39 of the latter endoscope toextend the. top of the outer tube 3 and the metal tip 5 from the forcepsopening 36 in the distal end 33, instead of a conventional forceps. Thedistal end 33;and flexible tube 32 are inserted into the cavity of ahuman body, together with the outer tube 3 and metal tip 5 of thesurgical instrument. Then, the diseased portion is observed through theocular 37 and viewing window, and the inclined angle of the extendedportion of the outer tube 3 is adjusted by operating the forceps raisingmechanism to allow the metal tip 5 to contact with the diseased portion.Operation of the surgical instrument is similar to that detailed inconnection with FIG. 1 and thus omitted in the description.

With the described surgical devices, the diseased portion of the humanbody may be frozen by direct contact with the metal tip which has beencooled in the following manner. The liquid refrigerant contained in thecontainer 13 is sucked into the inner tube 4 and then sprayed orprojected from the nozzle 6 into the evaporating space between thenozzle 6 and the inner surface of the metal tip 5, by driving the vacuumpump 12 to evacuate said evaporating space through the discharge tube 11and the outer tube 3. The projected refrigerant may be evaporated in theevaporation space to effectively cool the metal tip, since theevaporating space has large dimensions relative to the opening of thenozzle. The dimensions of the evaporating space may be adjustablychanged by moving the inner sleeve 7 through the outer sleeve 8 alongits longitudinal axis, so that the temperature of the metal tip may beeasily controlled.

- The vacuum means such as pump 12 evacuates the cylindrical spacebetween the outer tube 3 and inner tube 4, so that the liquidrefrigerant in the container 13 may be introduced into the evaporatingspace through the inner tube 4, and also the nozzle 6 and the liquidrefrigerant flowing through the inner tube may be thermally insulatedfrom the outside.

In the surgical device according to the present invention supplementalmeans for pressuring the liquid re-' frigerant may be added to thevacuum means so as to introduce the refrigerant into the evaporatingspace.

What we claim is:

l. A surgical device for treating a diseased portion comprising an innertube having one end dipped in a liquid refrigerant and the other endprovided with a nozzle, an outer tube spaced from and surrounding atleast the other end portion of the inner tube and the nozzle, said tubesbeing movably disposed relative to each other, the outer tube having afreezing tip at one end disposed at a distance from the nozzle to definean evaporating space therebetween, vacuum means for evacuating the spacebetween the outer periphery of the inner tube and the inner periphery ofthe outer tube and the evaporating space, to introduce the liquidrefrigerant from said one end of the inner tube to the evaporatingspace, whereby the refrigerant is evaporated in said evaporating spaceto cool said freezing tip, the evaporated refrigerant then passingthrough the space between the. inner and outer tubes to thermallyinsulate from the ambient the liquid refrigerant passing through theinner tube, said vacuum means being connected to an outer sleeve fixedto the inner sleeve, an

inner sleeve coaxially inserted in said outer sleeve and movable alongits axis, one end of said inner sleeve being connected to the other endof said outer tube, and a member for fixing the position of the innersleeve relative'to the outer sleeve, whereby to adjust the distancebetween the nozzle and freezing tip to control the dimensions of theevaporating space.

2. The surgical device according to claim 1 wherein said inner and outertubes are flexible tubes,

3. The surgical device according to claim 2 wherein said flexible tubesare made of thermal insulating substance.

4. The surgical device according to claim 3 wherein the thermalinsulating substance is polyfluoroethylene.

5. The surgical device according to claim 2 wherein the freezing tip isattached to the end of the outer tube and made of metal.

6. The surgical device according to claim 1 which further comprisesmeans for observing the freezing tip.

7. The surgical device according to claim 6 wherein said observing meansis a cycstoscope comprising a sheath through which the outer tube isinserted to extend the freezing tip from an open end of the sheath, anda light guide inserted in the sheath for illuminating the area aroundthe freezing tip.

8. The surgical device according to claim 6 wherein said observing meansis a cystoscope comprising a sheath with an opening and window which areformed near one end of the sheath, a light guide inserted in the sheathto illuminate the viewing field of the window, and a telescope slidablyinserted in the sheath and having an ocular and optical system opticallyconnecting the ocular to the window, the outer tube being slidablyinserted through the sheath with the freezing tip extended from theopening in the sheath.

9. The surgical device according to claim 6 wherein said observing meansis an endoscope comprising a distal end with a viewing window,illuminating window, opening, and a raising mechanism, a flexible tubeon one end of which the distal end is mounted, and a control unitmounted on the other end of the flexible tube having an inlet openingand an ocular optically connected to the viewing window in the distalend, the outer tube being slidably inserted into the control unit inletopening and through the endoscope, so that said one end of the outertube and the freezing tip are extended from the opening in the distalend, and the extended portion of the outer tube end being adjustablyinclined by the raising mechanism.

10. The surgical device according to claim 1 which further comprises acontainer for the liquid refrigerant in which said one end of the innertube is dipped.

11. The surgical device according to claim 10 wherein said one end ofthe inner tube is provided with afilter.

1. A surgical device for treating a diseased portion comprising an innertube having one end dipped in a liquid refrigerant and the other endprovided with a nozzle, an outer tube spaced from and surrounding atleast the other end portion of the inner tube and the nozzle, said tubesbeing movably disposed relative to each other, the outer tube having afreezing tip at one end disposed at a distance from the nozzle to definean evaporating space therebetween, vacuum means for evacuating the spacebetween the outer periphery of the inner tube and the inner periphery ofthe outer tube and the evaporating space, to introduce the liquidrefrigerant from said one end of the inner tube to the evaporatingspace, whereby the refrigerant is evaporated in said evaporating spaceto cool said freezing tip, the evaporated refrigerant then passingthrough the space between the inner and outer tubes to thermallyinsulate from the ambient the liquid refrigerant passing through theinner tube, said vacuum means being connected to an outer sleeve fixedto the inner sleeve, an inner sleeve coaxially inserted in said outersleeve and movable along its axis, one end of said inner sleeve beingconnected to the other end of said outer tube, and a member for fixingthe position of the inner sleeve relative to the outer sleeve, wherebyto adjust the distance between the nozzle and freezing tip to controlthe dimensions of the evaporating space.
 2. The surgical deviceaccording to claim 1 wherein said inner and outer tubes are flexibletubes.
 3. The surgical device according to claim 2 wherein said flexibletubes are made of thermal insulating substance.
 4. The surgical deviceaccording to claim 3 wherein the thermal insulating substance ispolyfluoroethylene.
 5. The surgical device according to claim 2 whereinthe freezing tip is attached to the end of the outer tube and made ofmetal.
 6. The surgical device according to claim 1 which furthercomprises means for observing the freezing tip.
 7. The surgical deviceaccording to claim 6 wherein said observing means is a cycstoscopecomprising a sheath through which the outer tube is inserted to extendthe freezing tip from an open end of the sheath, and a light guideinserted in the sheath for illuminating the area around the freezingtip.
 8. The surgical device according to claim 6 wherein said observingmeans is a cystoscope comprising a sheath with aN opening and windowwhich are formed near one end of the sheath, a light guide inserted inthe sheath to illuminate the viewing field of the window, and atelescope slidably inserted in the sheath and having an ocular andoptical system optically connecting the ocular to the window, the outertube being slidably inserted through the sheath with the freezing tipextended from the opening in the sheath.
 9. The surgical deviceaccording to claim 6 wherein said observing means is an endoscopecomprising a distal end with a viewing window, illuminating window,opening, and a raising mechanism, a flexible tube on one end of whichthe distal end is mounted, and a control unit mounted on the other endof the flexible tube having an inlet opening and an ocular opticallyconnected to the viewing window in the distal end, the outer tube beingslidably inserted into the control unit inlet opening and through theendoscope, so that said one end of the outer tube and the freezing tipare extended from the opening in the distal end, and the extendedportion of the outer tube end being adjustably inclined by the raisingmechanism.
 10. The surgical device according to claim 1 which furthercomprises a container for the liquid refrigerant in which said one endof the inner tube is dipped.
 11. The surgical device according to claim10 wherein said one end of the inner tube is provided with a filter.